Global Wellness Institute: Wellness Coaching Initiative

Section 1: Introduction The Global Wellness Institute, Wellness Coaching Initiative embarked on this White Paper to provide clarity on the Health and Wellness Coaching profession globally. The objective is to describe its emerging role in empowering better health and well-being, and to help people around the world find a Health and Wellness Coach with professional credibility within established professional standards and scope of practice. The aim of this White Paper is to highlight what needs to happen for Health and Wellness Coaches to better meet societal demands globally by empowering the public to take control of their own health and wellness. The global prevalence of preventable chronic diseases associated with unhealthy behaviors has reached epidemic proportions and negatively affects healthcare systems and economies worldwide. (Bloom et al., 2011; Meetoo, 2008; Centers for Disease Control and Prevention, 2016). Given the strain of chronic illness on public health and disease management, clinical practice and employee assistance programs are evolving to support individuals to change their health behaviors to prevent and better manage disease (Merrick et al.,2008; Baicker et al., 2010; Wolever et al., 2013). One rapidly emerging strategy to facilitate this endeavor is Health and Wellness Coaching (Wolever et al., 2013). This modality empowers individuals to make supportive, sustainable lifestyle and health behavior changes using Health and Wellness Coaches. Scientific evidence continues to show that diet, lifestyle, and environment are critical factors in creating optimal health. One important factor in the etiology of chronic diseases including cardiovascular disease, obesity, and cancer is chronic inflammation, which can be influenced by nutrition and daily lifestyle choices. EPIC, a landmark long-term study of 23,000 people in 2016 studied the health impact of four simple behavioral choices – smoking cessation, exercising 3.5 hours weekly, eating a healthy diet and maintaining a healthy weight. Researchers followed up eight years later and found that people who adhered to the recommended lifestyle choices had a 78% lower overall risk of developing chronic disease. They reported 93% reduction in diabetes, 81% reduction in heart attacks, 50% less stroke and 36% fewer cancers (Ford et al., 2009). These data demonstrate that dietary choices, consistent exercise, and daily lifestyle choices based on the best science available can improve overall health. The importance of immune health has grown during COVID-19. Researchers have concluded metabolic and microbiome health are important determinants of this aspect of our health. As with chronic diseases, diet and lifestyle choices either support or undermine metabolic and microbiome health affecting overall immune function. Evidence has WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 11

shown that choosing a diet that balances lipids, blood sugar and inflammation to promote metabolic health and a high-fiber diet for microbial health supported by the synergistic effects of sleep, exercise and stress management for microbiome health is effective in strengthening the immune system (Global Wellness Summit, 2021). However, COVID-19 has created obstacles for living a healthy lifestyle. With the challenges of self-quarantining impacting family life during the pandemic, people are resorting to takeaway food, resulting in poor nutrition, which on top of stress undermines their health (Opler, 2020). In addition to the challenge of maintaining good routines around nutrition, exercise and stress management, people are struggling to connect with others, spend time in nature and maintain a positive outlook. These are all areas where Health and Wellness Coaches can add value and assist in overcoming these challenges (Bodecker, G., personal communication, December 2020). Many individuals struggle to make changes that would enable health improvement (Prochaska & Prochaska, 2016). Multiple conditions call for health-related behavioral changes. However, many people prove unable to make or to sustain these changes and it would seem that the traditional methods of information-sharing and professional advice alongside other efforts to modify health-related behaviors have been of limited effectiveness (Kelly et al., 2016). Given the growing number of individuals with health needs and the significant difficulties in helping many of those engage in appropriate lifestyle changes, there is a compelling case for alternatives to the ‘expert-led’ approach and developing Health and Wellness Coaching to support individuals to cultivate autonomy, selfaccountability and empower themselves to create and maintain health and well-being. We are experiencing a new era of personalized care, with active participation in optimizing health. At the heart of this personalized health care system is support for the individual to engage in their own well-being in ways that are not only sustainable and cost-effective but offer outcomes for personal and public health and for the economy. Dr Jeffrey Bland, Functional Medicine Pioneer, states that there is an evidence-based shift to a personalized-care approach in medicine, with intensive patient management and disease-prevention strategies ultimately proving to be more effective than the current episodic treatment of disease (Bland, 2015). Published literature reviews and compendiums on the effectiveness of Health and Wellness Coaches have focused on the reduction of medical risk factors prevalent in the population today. This research was conducted predominantly in healthcare settings and may have been influenced by WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 12

cultural aspects and demographic diversity. During the pandemic, where underlying health conditions increase the risk of death, the value of Health and Wellness Coaching takes on an additional dimension. Health and Wellness Coaches have an important role to play in preventative health by supporting people to adopt or maintain health behaviors that will serve to protect them against pandemics. Further studies reveal evidence of the usefulness of Health and Wellness Coaching in a wide range of situations (Sforzo et al., 2017). The National Health Service (NHS) in England (2014) is focused on patient empowerment in the context of personalized care requiring a long-term partnership with patients. The need for novel interventions and approaches to service delivery suggest that a Health and Wellness Coach with a whole person approach could be placed at the heart of their care. Health and Wellness Coaching offers a significant contribution both as a standalone intervention and as an adjunctive service to more traditional health care interventions. The Health and Wellness Coach supports individuals in making healthy choices for sustainable behavior change and can help the public to proactively take charge of their health and well-being. COVID-19 has accelerated global development of the Health and Wellness Coaching profession in clinical practice, insurance health plans, corporate programs, schools/universities, and spas/retreats. This paper highlights the supportive role of Health and Wellness Coaches, the state of the profession globally, settings that services are delivered, the future of the profession and what needs to happen to further establish the profession to meet societal needs. WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 13

Section 2: Health and Wellness Coaching Definition WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 14

Section 2: Definition Health and Wellness Coaching Health and Wellness Coaching draws from psychological theories concerned with motivation and behavior change in order to devise coaching interventions that are tailored to the individual client (Jordan, 2021; Moore et al, 2016). This often results in the use of an eclectic range of theories and models from applied psychology and health disciplines (Wolever, 2019). Thus, a comprehensive training program in Health and Wellness Coaching is likely to draw upon areas that include motivational interviewing (Resnicow & McMaster, 2012); self-determination theory (American Psychological Association, 2021); transtheoretical models of change (Prochaska & Velicier, 1997); positive psychology (Park et al., 2014); cognitive behavioral principles and methods (Fenn et al., 2013); social cognition (Socia Cognition, n.d.); theories of emotional intelligence (Drigas & Papoutsi, 2018); mindfulness (Nilsson et al., 2016) and neuroscience (Dossey et al., 2015; Erickson et al., 2014). Neuroscience Motivational interviewing SelfDetermination Theory Mindfulness Theories of Emotional Intelligence Social Cognition Health & Wellness Coaching Cognitive Behavioral Principles Transtheoretical Model of Change Positive Psychology Although many coaches practice face-to-face, the recent global situation has necessitated an even greater prevalence of distance communication. Fortunately, coaching appears to be as effective when administered remotely by phone or the Internet when compared with face-to-face coaching (Gordon et al., 2016). This provides great flexibility, as coaching can be performed in person, over the phone, or via video conferencing. 15 WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022

The GWI Wellness Coaching Initiative studied peer-reviewed, evidencebased research publications to define the Health and Wellness Coaching profession globally and industry-leading governing bodies around the world. The leading research by Wolever et al. in 2013 (Wolever et al., 2013), reviewed published literature from 800 abstracts to define Health and Wellness Coaching. They concluded that: Health and Wellness Coaching is a patient-centered process that is based on behavior change theory. The coaching process entails goal setting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. Additionally, coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication and motivational skills. Consensus from the literature formed Wolever’s et al. Health and Wellness Coaching definition as: Patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and selfmonitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach. The coach is trained in behavior change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being (Wolever et al., 2013). There are three industry-leading Health and Wellness Coaching representative bodies around the world with definitions synergistic to Wolever et al.’s research: The National Board of Health and Wellness Coaching (NBHWC) in the United States The UK Health Coaches Association (UKHCA) in the United Kingdom and Ireland Health Coaches Australia and New Zealand Association (HCANZA) in Australia and New Zealand WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 16

Common themes defining Health and Wellness Coaching found in Wolever’s definition and reflected by the three industry-leading bodies are shown below. Shaded boxes indicate where the wording of the Health and Wellness Coaching theme is present in the definition. As a profession, Health and Wellness Coaching does not have a global standard for credentialing or regulation. Instead, the development of this emerging profession has been led by the United States and United Kingdom where it is the most advanced. In the US, the National Board of Health and Wellness Coaching (NBHWC) was established in 2012 and is the nationally recognized body for credentialing over 6,500 coaches. NBHWC established the first national standard for Health and Wellness Coaching in 2015. The Board emphasizes the importance of the coach positioning the client as the expert on their own life. Their published definition is: Health and Wellness Coaching is a client-centered, collaborative intervention whose primary aim is sustainable lifestyle change. Whilst coaches bring defined skills and knowledge to the process, the goals selected are client-determined and relate specifically to the health and wellness needs with the coach positioning the client WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 17

explicitly as the expert on their own life. Client accountability is central to the process (NBHWC, 2021). The United Kingdom Health Coaches Association (UKHCA) established in 2018, is the professional body for Health and Wellness Coaching in the UK and Ireland with over 600 members, and the first such professional body in the world. In 2020, the UKHCA undertook a comprehensive strategic review of Health and Wellness Coaching around the globe and added a unique perspective which recognizes that Health and Wellness Coaches support people in working toward whole health as a dynamic continuum of adaption and resilience. Whole health can be seen as a progressive state of being, when health (physical, psychological, mental, emotional, social and spiritual state) and wellness (activities, choices, and lifestyle) are in balance. UKHCA states that: Health and Wellness Coaching is a client-led, collaborative process that aims to promote self-management, self-empowerment and equip an individual to adapt positively to their internal and external environment to create a state of resilience through the pursuit of activities and a lifestyle that cultivates their whole-health continuum (Natrins, 2020). In 2019, Health Coaches Australia and New Zealand Association (HCANZA) was created as a first step to provide a voice for the profession. The aim of the Association is to gain awareness of the work that Health and Wellness Coaches do and their scope of practice, and to set local standards for professional membership of the Association, based on recognized qualifications. Professional members are given the title ‘accredited coach’ although certification exams are not in existence. Health and Wellness Coaches who have completed NBHWC approved programs in the U.S., or met equivalent standards, may apply to become a member. Several local training programs exist that are recognized at an Australian Qualifications Framework (AQF) Level 5 and in one case, have been approved by the NBHWC or their graduates are eligible to sit for NBHW certification. HCANZA also highlights the importance of developing resilience for longterm behavior change. HCANZA believes Health and Wellness Coaching encompasses the sciences of positive psychology, behavior change, nutrition, exercise, and lifestyle medicine with the dynamic art of relationships, teamwork and community. Their Health and Wellness Coach definition is: Health and Wellness Coaches focus on guiding and assisting their clients to develop the resilience advantage that long term behavior WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 18

change delivers health and wellness outcomes. Health and wellness coaching is a patient or client-centered approach that focuses on assisting them to elicit and clarify their values, gain insights into their lifestyle practices and develop a deeper understanding of possibilities and pathways to resolution of their challenges. For the patient or client, this is a journey of self-discovery that ultimately leads to them setting goals, accepting a level of selfresponsibility, and experiencing positive self-determination. It is this self-awareness and knowledge that inspires and motivates them to bridge the gap between intention and action (HCANZA, 2021). The Global Wellness Institute: Wellness Coaching Initiative’s definition of Health and Wellness Coaching is based on the synergy of Wolever’s et al.’s evidence-based research and industry-leading Health and Wellness Coaching representative bodies around the world. Additional components are the coaching approach and unconditional positive regard that empowers the client to be masters of their own health, wellness, and overall wellbeing: Health and Wellness Coaches work collaboratively with individuals and groups in a client-led process that supports the client in working toward self-determined health and wellness goals. Coaches support clients in using their self-awareness, insights, and personal strengths to develop management strategies for lasting behavior change. Coaches hold an unconditional positive regard as they empower the client to achieve their goals, using a process of discovery. Coaches support and encourage clients to become masters of their own health, wellness, and overall well-being (Global Wellness Institute Global Coaching Initiative, 2021). WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 19

Section 3: State of the Health and Wellness Coach Profession WELLNESS COACHING INITIATIVE WHITE PAPER FEBRUARY 8. 2022 20

Section 3: State of the Health and Wellness Coach Profession Health and Wellness Coaching is not credentialed or regulated globally. The development and establishment of this emerging profession has been led by the United States and the United Kingdom where it is most advanced. See visual below. United States In the United States, national standards were created for the profession by the National Board for Health and Wellness Coaching (NBHWC) in 2015. There is no law mandating these standards. The NBHWC certifies Health and Wellness Coaches who have successfully met and demonstrated its coaching competencies through examination and who adhere to ethical guidelines (NBHWC, 2021)

Health and Wellness Coaching from the United States, United Kingdom, Australia, Singapore, and Europe. Based on the synergy of Wolever et al.'s evidence-based research and industry-leading bodies, the GWI:WCI offers: A common definition of 'Health and Wellness Coaching' A review of the state of the nascent Health and Wellness Coaching